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2017 Form 1095-B - Internal Revenue Service

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560116. form 1095-B Health coverage VOID OMB No. 1545-2252. Department of the Treasury Internal Revenue Service . Do not attach to your tax return. Keep for your records. Go to for instructions and the latest information. CORRECTED 2017. Part I Responsible Individual 1 Name of responsible individual 2 Social security number (SSN) or other TIN 3 Date of birth (if SSN or other TIN is not available). 4 Street address (including apartment no.) 5 City or town 6 State or province 7 Country and ZIP or foreign postal code 9 Reserved 8 Enter letter identifying Origin of the Health coverage (see instructions for codes).

Form 1095-B Department of the Treasury 2017 Internal Revenue Service. Health Coverage Do not attach to your tax return. Keep for your records. Go to

  Form, Services, Internal revenue service, Internal, Revenue, Coverage, 1590, Form 1095 b

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